title: The second best arterial graft: a propensity analysis of the radial artery versus the free right internal thoracic artery to bypass the circumflex coronary artery.
abstract: OBJECTIVE
  We sought to determine if the radial artery (RA) or the free right internal thoracic artery (RITA) is the better conduit to bypass the circumflex coronary artery during coronary artery bypass grafting (CABG) using the left internal thoracic artery (LITA).
  
  
  METHODS
  Propensity matching was performed on 2488 CABG-LITA patients from 2 affiliated centers, resulting in 528 pairs who received either a RA at one center or a free RITA at the other center to bypass the circumflex coronary artery from 1995 to 2009.
  
  
  RESULTS
  Kaplan Meier estimated 1-, 5-, 10-, and 15-year survival rates were 99%, 95%, 85%, and 76% for RA patients, respectively, and 97%, 92%, 80%, and 71% for RITA patients, respectively (P = .060). Major adverse events (MAEs) were fewer in the RA group (7.6% vs 14.0%; P = .001) and use of the RA was a significant predictor of reduced MAEs (odds ratio [OR], 0.48; P = .002) in all patients and especially in diabetic (OR, 0.32; P = .003), older (OR, 0.40; P = .009), obese (OR, 0.15; P < .001), and chronic obstructive pulmonary disease (COPD) (OR, 0.05; P = .016) patients. However, survival was better with RA only in COPD (hazard ratio, 0.49; P = .045) and older (hazard ratio, 0.71; P = .050) patients. Overall RA patency (83.9%) was similar to RITA patency (87.4%) at a mean of 5.1 ± 3.8 years (P = .155).
  
  
  CONCLUSIONS
  Long-term survival is similar in CABG-LITA patients using either a RA or free RITA graft to bypass the circumflex coronary artery. RA grafting has fewer MAEs, a similar patency to RITA, and improves survival in older and COPD patients. The choice of the second arterial conduit should be guided by patient profiles and surgeon preferences.
authors.affiliation: Division of Cardiothoracic Surgery, Beth Israel Medical Center, New York, NY. Electronic address: rtranbau@chpnet.org.
authors.forename: Robert F
authors.initials: RF
authors.lastname: Tranbaugh
authors.affiliation: Division of Cardiothoracic Surgery, Beth Israel Medical Center, New York, NY.
authors.forename: Kamellia R
authors.initials: KR
authors.lastname: Dimitrova
authors.affiliation: Office of Grants and Research Administration, Beth Israel Medical Center, New York, NY.
authors.forename: David J
authors.initials: DJ
authors.lastname: Lucido
authors.affiliation: Division of Cardiothoracic Surgery, Beth Israel Medical Center, New York, NY.
authors.forename: Darryl M
authors.initials: DM
authors.lastname: Hoffman
authors.affiliation: Division of Cardiothoracic Surgery, Beth Israel Medical Center, New York, NY.
authors.forename: Gabriela R
authors.initials: GR
authors.lastname: Dincheva
authors.affiliation: Division of Cardiothoracic Surgery, Beth Israel Medical Center, New York, NY.
authors.forename: Charles M
authors.initials: CM
authors.lastname: Geller
authors.affiliation: Division of Cardiothoracic Surgery, St. Luke's Roosevelt Hospital Center, New York, NY.
authors.forename: Sandhya K
authors.initials: SK
authors.lastname: Balaram
authors.affiliation: Division of Cardiothoracic Surgery, Beth Israel Medical Center, New York, NY.
authors.forename: Wilson
authors.initials: W
authors.lastname: Ko
authors.affiliation: Division of Cardiothoracic Surgery, St. Luke's Roosevelt Hospital Center, New York, NY.
authors.forename: Daniel G
authors.initials: DG
authors.lastname: Swistel
mesh_terms: D000367:Age Factors; D000368:Aged; D016009:Chi-Square Distribution; D015897:Comorbidity; D001026:Coronary Artery Bypass / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D003324:Coronary Artery Disease / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D003920:Diabetes Mellitus / Q000401:mortality; D005260:Female; D006801:Humans; D007387:Internal Mammary-Coronary Artery Anastomosis / Q000009:adverse effects / Q000401:mortality; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009519:New York City; D016017:Odds Ratio; D018579:Patient Selection; D011183:Postoperative Complications / Q000401:mortality; D057216:Propensity Score; D016016:Proportional Hazards Models; D029424:Pulmonary Disease, Chronic Obstructive / Q000401:mortality; D017534:Radial Artery / Q000503:physiopathology / Q000637:transplantation*; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome; D014654:Vascular Patency
keywords: 23; 23.1; 38.2; BIMC; BITA; Beth Israel Medical Center; CABG; COPD; HR; LITA; MAE; OR; PS; RCA; RCT; RITA; SITA; SLR; SV; St. Luke’s Roosevelt Hospital Center; bilateral internal thoracic artery; chronic obstructive pulmonary disease; coronary artery bypass grafting; hazard ratio; left internal thoracic artery; left internal thoracic artery and saphenous vein grafts; major adverse event; odds ratio; propensity score; randomized controlled trial; right coronary artery; right internal thoracic artery; saphenous vein